Abstract: FR-PO1073
Adverse Childhood Experiences in Adolescents with Hypertension in an Inner-City Population in the Bronx, New York
Session Information
- Pediatric Hypertension, AKI, Urologic Disorders
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1700 Pediatric Nephrology
Authors
- Brathwaite, Kaye E., Montefiore Medical Center, Bronx, New York, United States
- Valdovinos, Roberto A., Children''s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
- Rubinstein, Tamar, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, United States
- Reidy, Kimberly J., Children's Hospital at Montefiore/ Albert Einstein College of Medicine, Bronxville, New York, United States
Background
Adverse Childhood Experiences (ACEs) are associated with hypertension (HTN) and increased risk of cardiovascular (CV) disease in adults, however less is known of risk factors in adolescence. The prevalence of HTN in adolescents is 3.5% and leads to increased CV risk in adulthood. We hypothesized: ACEs in adolescents are associated with increased CV risk factors, particularly HTN and end organ damage.
Methods
ACE survey was administered in both general pediatric and subspecialty clinics including 10 questions [max score 10 ACEs]. A retrospective study was used to assess whether ACE scores are associated with uncontrolled HTN and left ventricular hypertrophy (LVH) in adolescents. Using Clinical Looking Glass (a software to extract information from the electronic health record), data on ACE screenings at Montefiore Medical Center, latest blood pressures (BP) and echocardiograms were obtained. Adolescents ages >/=13 or <25 years old with a ICD10 diagnosis of HTN and a recorded ACE score were included. BP control was assessed with BP cutoff of 130/80mmHg and end organ damage was based on presence of LVH on echocardiograms.
Results
In 302 hypertensive patients, 38.7% were female and 61.3% male. 40.4% were African American, 10.9% Caucasian, 1.7% Asian, and 36.4% other/unknown race; 39.7% were Spanish/Hispanic/Latino. The median ACE score was 0 [IQR 0-1] adverse experiences. At least one ACE was reported in 44.4% of children and 20.8% had 2 or more ACEs. There was no difference in the age of completion of the ACE screen (16.6 ± 2.5 years with-ACE & 15.95 ± 2.3 years without-ACE), or in the average BP (128/76mmHg ± 13.6/8.8 with-ACE & 126/76mmHg ± 12.4/8.1 without-ACE). Using a cutoff of 130/80mmHg there was a trend toward worse BP control with ACE exposure: Uncontrolled BP was noted in 53% with an ACE vs. 43% without an ACE (p=0.09). Echocardiograms were present in 35.8% of patients and there was no difference in LVH (4.3% with-ACE and 4.8% without-ACE).
Conclusion
20.8% of adolescents with HTN in the Bronx report an ACE score of 2 or more, comparable to national data. Our findings suggest that BP control may be worse with ACEs present, however the data was limited by a small sample size. Additional study is needed to assess the impact of ACEs and resilience factors on BP control and end-organ damage in adolescents with HTN.